MEDICARE: WAYNE MEMORIAL COMMUNITY HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician
4	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1346854270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE MEMORIAL COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	601 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1445
Country	:	US
Telephone Number	:	570-253-8226
Fax Number	:	570-253-8228

Provider Business Practice Location Address
First Line	:	273 GRANDVIEW AVE
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1163
Country	:	US
Telephone Number	:	570-390-4545
Fax Number	:	570-390-4546

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERESA LACEY
Credential	:
Telephone Number	:	570-253-8451

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	03/05/2024

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273 GRANDVIEW AVE STE 4
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Practice Location Address:

273 GRANDVIEW AVE
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